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1. Your age is over 35: Biological clock is an important risk factor. As women age, fewer eggs become available for ovulation and egg quality deteriorates. As a result, after age 35, fertility potential starts to decline and eggs become more susceptible to chromosomal abnormalities. Women over 35 also have a higher chance of miscarriage.

2. You have irregular periods and/or experience bleeding or spotting between periods: This might be an indication of ovulation problems which is a cause of infertility.

3. You have a history of recurrent miscarriages: These may be caused by abnormalities of the uterus. An infection of the uterus or low hormone levels can also trigger recurrent miscarriages.

4. You are extremely underweight or overweight: Being overweight can result in overproduction of estrogen and this may prevent pregnancy. Being underweight can result in a lack of estrogen, which might disrupt the menstrual cycle.

5. You and/or your partner have chronic diseases such as diabetes or hypothyroidism: These diseases can hinder embryo implantation.

6. You have history of sexually transmitted diseases (STDs) such as chlamydia and gonnorhea: These can result in pelvic inflammatory disease and blocked fallopian tubes.

7. You have abnormal pelvic pain during your periods or sexual intercourse: These symptoms may indicate endometriosis, tubal disease, pelvic inflammatory disease, or fibroids, all of which can negatively affect fertility.

8. You smoke or consume excessive amounts of alcohol: Both are detrimental on reproductive health of males and females.

3. We will perform an ultrasound examination and start stimulating your ovaries when you come to Istanbul. Treatment may be initiated any time within the first 3 days of your menstrual bleeding.

Short Antagonist Protocol

1. Stop smoking if you are a smoker.

2. Start using Folic acid pills 0.4 mg/day.

3. Come to the clinic directly on the second or third day of your cycle.

4. We will perform an ultrasound examination and start stimulating your ovaries when you come to Istanbul. Treatment may be initiated if certain conditions are met such as the absence of cysts and the presence of a thin endometrium.

5. In women planned to be treated with the antagonist protocol there is a 10-15% risk of not being able to initiate the treatment due to the presence of functional ovarian cysts or a early growing follicle that will suppress the stimulation of other follicles.

The importance of a thorough evaluation of both partners in the relationship cannot be overestimated. Male factors account for at least 30 to 50 percent of all fertility issues in patients.

Semen Analysis

The semen analysis is done on an ejaculated sample collected after masturbation. It is best to do this test after a patient has abstained from sexual activity for two to five days. The test can be inaccurate if there has been recent ejaculation (counts too low) or if ejaculation has not occurred in a long time (too many dead sperm). Once the sample has been taken to the laboratory, it is analyzed for many different parameters, including fluid volume, sperm numbers, sperm motility (the percentage of moving sperm), and sperm morphology (the shape and appearance of the sperm). Variations can occur from test to test, even in the same man, and sometimes the test needs to be repeated.

Varicocele

A urologist often is consulted after an abnormal semen analysis is obtained. The most common abnormality discovered by the urologist is a “varicocele.” A varicocele is a dilated vein around the testicle, which raises the core temperature of the testicle and can impair the process of making sperm. The correction of a varicocele involves a minor surgical procedure. The procedure ligates the dilated vein, which improves blood flow around the testicle.

Note: The calendar shown above is an example of how an IVF cycle may evolve. It is possible that the ovarian stimulation process is shorter or longer than above depending on your response. A Day3 or Day5 (blastocyst) transfer will be based on the embryo development. A pregnancy test is performed 9-11 days past transfer.

You will meet with one of our physicians, at which time we will review your medical history and establish your unique IVF treatment plan.

Pretreatment Preparation

Pretreatment testing will include blood work to determine hormone levels, blood tests , a semen analysis (if applicable), and a uterine assessment. In order to have the optimal outcome with your IVF treatment, we review your medical history and the results of your pretreatment testing before we finalize a protocol that is tailored for you.

IVF Coordinator Consultation

you will meet with one of our IVF coordinators to review your protocol and plan your calendar.

Controlled Ovarian Hyperstimulation

An IVF cycle begins with ovarian stimulation and ultrasound monitoring. A baseline pelvic ultrasound will ensure a healthy starting point before initiating medication for the stimulation and assessment of egg production. You will take hormone injections to recruit multiple eggs from your ovaries. During this time, follicular development and hormone levels will be monitored for appropriate growth for several days. Once your follicles have reached the ideal size, you will be ready for egg retrieval.

IVF Laboratory

Ultrasound-guided, transvaginal egg retrieval is a procedure in which a long, thin needle is passed through the vaginal wall into the ovary. The physician aspirates the follicles from each ovary and the follicular fluid is collected in test tubes, where the embryologist carefully searches for the eggs. The eggs are cleaned, counted, and placed in an incubator. Later that day, the eggs are fertilized with sperm either by standard insemination or Intracytoplasmic sperm injection(ICSI). Injuries during this procedure are extremely rare. Structures near the ovaries, such as the bladder, bowel, or blood vessels, could possibly be injured and require further surgery. Limited bleeding from the ovaries may occur, but the need for transfusion is extremely rare. Infections following transvaginal egg retrieval are also possible, but are rare.

Embryo Culture and Assessment

During IVF, your embryos are cultured for up to six days in a temperature-controlled incubator. Each day the embryos are evaluated for quality and development. This information is shared with the doctors to help determine the appropriate day for embryo transfer, which is typically performed on day three or day five of embryo culture or day six in the case of PGS/PGD. Our embryologists will call you each day to update you on the embryo quality and to answer any questions you may have.

Embryo Transfer or Blastocyst Transfer

Embryos are typically transferred back to the uterus on day three, when the embryo is at a multicell stage, or day five or six, when the embryo is at a blastocyst stage. This simple procedure usually requires no anesthesia. Your doctor and embryologist will discuss the number of embryos to transfer that will provide you the highest probability of success and the lowest probability of high-order multiple births. You will be given ample time to discuss your embryos and decide on the number of embryos to transfer. You also will receive pictures of your embryos being transferred. You will relax in the room for a short period of time once the embryo transfer is complete. The transfer itself may cause mild irritation to the cervix or uterus.

Pregnancy Test

We will schedule your pregnancy test 10-12 days after your transfer. When your first pregnancy test is positive, a repeat value will be obtained approximately 48 to 96 hours later. To confirm the positive pregnancy test, we will schedule an obstetrical ultrasound two weeks following the second pregnancy test. At this visit we will be confirming the implantation of embryo(s) and fetal heart motion.

What is IUI?

IUI involves a laboratory procedure to separate fast-moving sperm from more sluggish or non-moving sperm. It can be performed with your partner’s sperm or donor sperm (known as donor insemination).

Is IUI for me?

You may be offered IUI if:

you are unable (or would find it very difficult) to have vaginal intercourse, for example because of a physical disability or psychosexual problem

you have a condition that means you need specific help to conceive (for example, if you’re a man who is HIV positive and you have undergone sperm washing to reduce the risk of passing on the disease to your partner and potential child).

In the past IUI was offered if you had unexplained infertility, mild endometriosis or when a male partner had mild fertility problems. However, the National Institute for Health and Clinical Excellence (NICE) (an organisation which provides national guidance and advice to improve health and social care) has advised that it should now not routinely be offered in these situations except for in exceptional circumstances.

Instead, if this applies to you, you are advised to try to conceive for a total of two years before IVF will be considered (this can include up to one year before your fertility investigations).

Drug reaction

A mild reaction to fertility drugs may involve hot flushes, feeling down or irritable, headaches and restlessness. Symptoms usually disappear after a short time but if they do not, you should see a doctor as soon as possible.

Ovarian hyper-stimulation syndrome (OHSS)

OHSS can be a dangerous over-reaction to fertility drugs used to stimulate egg production. It can cause symptoms such as a swollen stomach, stomach pains, nausea and vomiting.

If you start to experience any of these symptoms you must contact your doctor immediately.

Risks of fertility treatment – OHSS

Miscarriage

Although the risk of a miscarriage after IVF is no higher than after a natural conception, nor is the risk lower.

Your clinic will arrange an early pregnancy ultrasound scan if you conceive after IVF. This is to check that the pregnancy is not likely to miscarry. The scan is usually done about two weeks after the positive pregnancy test.